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COLLECTOR I - BUSINESS SERVICE-MANAGED CARE
Costa Mesa, CA PRIMARY DUTIES AND RESPONSIBILITIES The Collector serves as the account representative for **MEMBERS ONLY**SIGN UP NOW*** in working with insurance companies, government payors, and/or patients for resolution of payments and accounts resolution. Completes assigned accounts within assigned work queues. Obtains the maximum amount of reimbursement by evaluating claims at the contract rate with the use of the contract management tool for proper pricing (Examples: APC, DRG, APRDRG). Reviews and initiates the initial appeal for underpayments observing all timely requirements to secure reimbursement due to **MEMBERS ONLY**SIGN UP NOW***. Reviews and completes payor and/or patient correspondence in a timely manner. Escalates to the payor and/or patient accounts that need to be appealed due to improper billing, coding and/or underpayments. Reports new/unknown billing edits to direct supervisor for review and resolution. Has a strong understanding of the Revenue Cycle processes, from Patient Access (authorizations & admissions) through Patient Financial Services (billing & collections), including procedures and policies. Has thorough knowledge of managed care contracts, current payor rates, understanding of terms and conditions, as well as Federal and State requirements. Interprets Explanation of Benefits (EOBs) and Electronic Admittance Advices (ERAs) to ensure proper payment as well as assist and educate patients and colleagues with understanding of benefit plans. Understanding of hospital billing form requirements (UB04) and familiar with the HCFA 1500 forms. Knowledge of HMO, POS, PPO, EPO, IPA, Medicare Advantage, Covered California (Exchange), capitation, commercial and government payors (i.e. Medicare, Medi-Cal, TriCare, etc) and how these payors process claims. Demonstrates knowledge of and effectively uses patient accounting systems. Documents all calls and actions taken in the appropriate systems. Accurately codes insurance plan codes. Establishes a payment arrangement when patients are unable to pay in full at the time payment is due. May review for applicable cash rates, special rates, applicable professional and employee discounts. May process bankruptcy and deceased patient accounts. Performs other duties as assigned. Consistently meets individual productivity and quality assurance standards Performs other duties as assigned. EDUCATION AND EXPERIENCE REQUIRED: *High School diploma or equivalent *One year of previous hospital business experience or equivalent or a strong background in customer service *Basic experience with insurance plans, hospital reimbursement methodology, and/or ICD10 and CPT coding |
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